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Mental health clinicians define psychological disorders as:

  • Deviant, distressful, and dysfunctional patterns of thoughts, feelings, or behaviors.

  • Deviant:

    • thoughts and behaviors different from the cultural context.

    • Standards change across cultures and situations.

      • ex: Killing in combat vs. murder in peacetime.

  • Distress:

    • Subjective feeling that something is wrong.

  • Dysfunction:

    • Harmful impairment of ability to work and live.

Intro to Psychological Disorders

Nellie Bly's Expose (1887)

  • Journalist Elizabeth Cochrane used the alias Nellie Bly. Posed as mentally ill to investigate conditions in psychiatric hospitals in the US.

  • Exposed:

    • Rotten food

    • Cold showers

    • Rats

    • Abusive nurses

    • Patients tied down

  • Her work, Ten Days in a Madhouse, triggered mental health reform.

David Rosenhan's Experiment (1975)

  • Published "On Being Sane in Insane Places."

  • Experiment on psychiatric institutions.

  • Part 1:

    • Sent eight mentally sound associates (including himself) to institutions.

    • They claimed to be hearing voices.

    • Once admitted, they acted normally.

    • Goal: to see if administrators would recognize their sanity.

    • Findings:

      • Easy to get into mental institutions.

      • Hard to get out.

      • Average stay: 19 days (one participant stayed 52 days).

      • Forced to take psychotropic medication (spit it out secretly).

      • Discharged with a diagnosis of "paranoid schizophrenia in remission."

  • Part 2:

    • Rosenhan told a teaching hospital he'd send more pseudo-patients.

    • Challenged staff to identify imposters.

    • Staff identified 41 out of 193 new patients as likely pseudo-patients.

    • Rosenhan never sent any pseudo-patients.

  • Conclusions:

    • Psychiatric diagnoses reflect the situation more than the patient.

    • 1 bad thing overlaps multiple good things

      • ex. Saying you heard voices once gets more attention than weeks of normal behavior.

  • Questions Raised:

    • How do we define, diagnose, and classify mental disorders?

    • When does sad become depressed? Quirky become obsessive-compulsive? Energetic become hyperactive?

    • What are the risks and benefits of diagnostic labeling?

    • How does the field evolve?

Historical Perspectives on Mental Health

  • 18th-19th centuries: Notion that mental health issues might be about a sickness in the mind.

  • 1800s: Doctors realized advanced syphilis could cause neurological problems and mental disorders.

  • Medical Model: The idea that psychological disorders have physiological causes.

    • Can be diagnosed based on symptoms.

    • Can be treated and sometimes cured.

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Biopsychosocial Approach: considers psychological, biological, and sociocultural influences

  • Everything psychological is simultaneously biological.

    • Psychological influences (stress, trauma, memories).

    • Biological factors (genetics, brain chemistry).

    • Social-cultural influences (cultural expectations of normal behavior).

  • Broader view: some disorders can be cured, others coped with, and some may not be disorders at all.

Biopsychosocial Model: to fully understand health and illness, biological, psychological and social factors must be considered

  • by George Engel - 1970s

Psychological Perspectives on Disorders

  • Eclectic

  • Behavioral

  • Psychodynamic

  • Humanistic

  • Cognitive

  • Evolutionary

  • Sociocultural

  • Biological

Eclectic Approach in Diagnosis: using multiple perspectives or methods to understand/treat a disorder

  • behavioral

  • biological

  • cognitive

  • humanistic

ex. Justin has depression, an electric psychologist might:

  • use medication (biological)

  • teach coping skills (cognitive/behavioral)

  • explore personal growth (humanistic)

Behavioral Perspective: disorders from learned behavior/association

could be learned by:
Classical Conditioning → ex. phobias

  • got bitten by dog → brain links dog (NS) with pain (UCS) → everytime u see dog, u feel scared (CR)

  • phobia of dogs through learned association

Operant Conditioning → ex. self-harm

  • bad emotions → self harm → sh = relief → sh seen as reward → behavior is reinforced

  • sh = relief = repeated

Psychodynamic Perspective: focuses on unconscious thoughts, feelings and childhood experiences → finding unresolved conflicts and repressed emotions as the root

Humanistic Perspective: disorders from lack of social support → leads to them not able to grow to their potential

  • focuses on how you see yourself and the world

  • belief that you need love, acceptance and purpose to feel mentally healthy

  • Carl Rogers

Cognitive Perspective: the way you think about a situation, (usually bad thoughts) but the approach focuses on fixing that (good thoughts)

Evolutionary Perspective: behavior in the past may have been useful and good (helps survival) but now is bad and hurtful

ex. in the past “anxiety” would be helpful for being alert → noticing danger

now it can lead to panic attacks or chronic stress → not useful

Sociocultural Perspective: the influence of social, cultural, and environmental factors

  • societal pressures can contribute to mental health issues

Biological Perspective: disorders from physiology of genetics

  • imbalance of neurotransmitters

  • brain abnormalities

  • inherited vulnerabilities

Diathesis-Stress Model: theory abt how genetic predispositions (diathesis) interact with environmental stressors → increasing the risk of mental disorders

    analogy. Imagine a seed (diathesis) that has the potential to grow into a flower. If the seed is planted in fertile soil (low stress), it will likely grow well. However, if the soil is poor or there's a drought (high stress), the seed might not grow at all, or it might grow poorly. The seed's potential (diathesis) interacts with the environment (stress) to determine the outcome.

Flat Affect: lack of emotional expression

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DSM (Diagnostic and Statistical Manual of Mental Disorders)

  • Used to standardize and measure disorders

DSM-5 (5th edition):

  • American Psychiatric Association

  • Focused on mental disorders

  • Mainly used for clinical diagnosis and research.

  • New edition = updated research and evolving understanding of mental health.

    • ex. Homosexuality was classified as a pathology in the first two editions but removed in 1973.

  • Detailed, with symptoms and criteria's

  • Criticisms of DSM:

    • Potential for over or misdiagnosis and treatment.

    • Labeling patients can lead to judgments and preconceptions.

  • Clusters:

        Cluster A - “Odd, Eccentric”

                1. Paranoid Personality Disorder

                            -suspicious of others
                            -belief that others are trying to harm them

                    2. Schizoid Personality Disorder

                            -detached from social relationships

                            -limited emotional expressions

                            -prefers being alone

                    3. Schizotypal Personality Disorder

                            -off beliefs/magical thinking

                            -eccentric behavior

            Cluster B - “Dramatic, Emotional, Unpredictable”

                    1. Borderline Personality Disorder

                            -unstable moods/rapid mood swings (very rapid)

                            -impulsive

                            -intense fear of abandonment

                            -chronic feelings of emptiness/identity disturbance

                    2. Narcissistic Personality Disorder

                            -sense of self-importance

                            -need for excessive admiration

                            -lack of empathy

                            -exploitative relationships

                    3. Histrionic Personality Disorder

                            -excessive attention-seeking

                            -dramatic

                            -shallow emotions

                            -constant need of approval

                            -easily influenced

                    4. Antisocial Personality Disorder

                            -disregard for others

                            -lying/deceitfulness

                            -impulsive/aggressive

                            -lack of remorse

            Cluster C - “Anxious, Fearful”

                    1. Avoidant Personality Disorder

                            -fear of criticism/rejection

                            -avoids social situations (wants close relationships)

                            -feelings of inadequacy

                    2. Dependent Personality Disorder

                            -excessive need to be taken care of

                            -fear of separation

                            -difficulty making decisions

                    3. Obsessive Compulsive Personality Disorder

                            -preoccupation with order, perfectionism, and control

                            -inflexibility with morals, ethics or values

                            -diff from OCD (anxiety disorder)

ICD (International Classification of Diseases)

  • Similar to DSM but international and more brief and medically-oriented

  • Used for healthcare system for diagnosis and billings

  • Includes ALL diseases not just mental

Positive Psychology

Positive Psychology Approach

Focuses on “What makes life worth living” and well-being

Gratitude:

Appreciating the positive aspects

    improves:

  • well being

  • life satisfaction

  • optimism

VIA Classification System

A system to organize our 24 character strengths (some stronger some weaker)

  • Helps understanding our best qualities

  • Grouped under 6 main categories:

1) Wisdom - Thinking and Learning

  • Creativity, Curiosity, Love of Learning, Perspective, Judgement

2) Courage - Taking action despite fear

  • Bravery, Honesty, Perseverance, Zest (Enthusiasm)

3) Humanity - Building Relationships

  • Love, Kindness, Social intelligence

4) Justice - Helping the group or community

  • Fairness, Leadership, Teamwork

5) Temperance - Self-control and Moderation

  • Forgiveness, Humility, Self-Regulation, Prudence (Wise Decision-Making)

6) Transcendence - Connecting to smt bigger

  • Gratitude, Hope, Humor, Appreciation of Beauty, Spirituality

Posttraumatic Growth: Positive change after dealing with a tough event

    improves:

  • appreciation for life

  • stronger relationships

  • personal strength

Broaden-and-Build Theory: Explains how positive emotions can broaden your perspective and build your health

Who Can Help Jiayus TuTu

Wisdom

Courage

Humanitary

Justice

Temperance

Transcendence

Stress

Stress: physiological response that increases your vulnerability to various disorders and diseases

Types of stress:
Eustress: stress that motivates you to become better 👍👍

Distress: stress that overwhelms you, hinders performance/well-being. 👎👎

ACEs (Adverse Childhood Experiences)

  • stressful/traumatic experiences in childhood that leave a impact on your health and development

    ex.

    • Abuse: physical, emotional, sexual

    • Neglect: physical, emotional

    • Household Dysfunction: mental illness, substance abuse, domestic violence, incarceration

Reactions:

GAS (General Adaptation Syndrome) - Hans Selye

The body’s response to stress in 3 stages (body’s alarm system)

  1. Alarm Reaction: initial response when you first encounter stress → body goes in high alert

  2. Resistance Phase: actively confronting the stress through fight-flight-freeze response

  3. Exhaustion Phase: your stress resources are used up → most susceptible to illness during this phase

Tend-and-Befriend Theory - Shelly Taylor

  • Theory that some people (usually women) react to stress by tending to their own needs (self care) and seeking support

    • Nurturing behaviors and building social bonds

  • Contrasts with traditional fight-or-flight

  • Oxytocin - stress reducing effects (cortisol = stress hormones) but can make u more stressed if in a stressful environment

Cognitive Appraisal Theory:

  • Theory that our emotions are based off how we view an event

  • by Richard Lazarus

Coping:

Problem-Focused Coping

Sees problem and directly solves it

  • problem solving

  • time management

Emotional-Focused Coping

managing emotions to reduce negative feelings towards stress

  • relaxation techniques

  • meditation

  • medication

Psychological Disorders

Anxiety Disorders:
Anxiety: distressing, persistent worry about various aspects of life, often resulting in physical symptoms such as increased heart rate and fatigue.

OCD (obsessive compulsive disorder)

Unwanted repetitive thoughts (impulsive) and/or actions (compulsions)

  • Compulsions are used to relieve intense anxiety

  • Thoughts and behaviors are driven by obsessive fears

Treatment:

  • Psychotherapy, psychotropic drugs

GAD (Generalized Anxiety Disorder)

Continuous feelings of tension and anxiety/stress for at least 6 months

  • Constant worrying, agitated, on edge

  • No cause of anxiety just persistent feelings of anxiety

Panic Disorder

Sudden episodes of intense dread or fear without warning

  • Usually flight response, even without known trigger

  • Can be from genetics, constant stress, psychological trauma

Phobias

Persistent, irrational fears of specific objects, activities, or situations → leads to avoidance of the phobia

  • Specific phobias usually focus on particular objects or situation

  • ex. Agoraphobia: dear of situations where escape is difficult

    • usually avoids going to open areas (outside

    • avoids closed areas

Social Anxiety
Fear of being judged, or embarrassed in social situations

  • Usually avoids specific social interactions

Culture-Bound Syndromes: disorders influenced by cultures → the way ppl express their reactions to traumatic/stressful events

  • subgroups like ataque de nervious and hikikomori are specific disorders that are influenced by the culture around them

Ataque de nervios: a panic disorder, most common in Puerto Rico and Latino cultures

    ex. in the Caribbeans, strong emotion expression is common and accepted especially in crisis:

  • when someone’s in distress, they express their feelings the way their culture/society “taught” them → Ataque de nervios

Hikikomori: extreme social withdrawal → isolation, most common in Japan and Asian cultures

    ex. in Japan, their culture strongly emphasizes academic success, family honor, social conformity:

  • someone that feels they’ve failed those expectations, withdraws from society to avoid shame and embarrassment

    ex. in Korea, they have something similar (sulk or study room syndrome) where young adults/teens withdraw to their rooms due to academic/family pressures

Taijin kyofusho: intense social anxiety, fear of offending/embarrassing others (body oder, behavior, facial expressions), also most common in Japan and Asian Cultures

→can lead to withdrawal

difference from western social anxiety:

taijin kyofusho

western social anxiety

focuses on causing harm/discomfort to others

focuses on being judged/criticized by others

Causes of Anxiety Disorders:

  1. Learning Associations

  • Classical Conditioning: learned by associating neutral things to fears

    ex. Learning to fear dogs after being associated with a bad experience, like a dog bite

    • Stimulus Generalization: once fear is learned, it can be spread to similar things

    • Reinforcement: avoiding what you're afraid of makes you feel better temporarily, which teaches you to keep avoiding it → keeping the fear going

    • Cognition: how you think about an event can increase/reduce anxiety

                ex. making small mistake and overthinking it → makes anxiety worse

  1. Biological Perspective

  • Neurotransmitter imbalances (serotonin, GABA, norepinephrine)

  • Family history

  • Brain structure/function (amygdala, prefrontal cortex)

  1. Maladaptive Thinking

  • overgeneralizing/catastrophizing

  • uncertainty

  1. Emotional Dysregulation

  • unable to manage intense emotions

  • heightened sensitivity

  • avoidance behaviors

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Neurodevelopmental Disorders:

  • usually appears during development period

  • affects behavior, cognition, social skills

Causes:
Environmental:

  • prenatal exposure to: toxins, alcohol, drugs

  • malnutrition during critical periods

  • traumatic brain injuries/infections

Physiological:

  • brain abnormalities

  • hormonal imbalances

  • neurotransmitter imbalances (dopamine, serotonin)

Genetic:

  • inherited traits/mutations

  • interactions between genes and environment

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Schizophrenic Spectrum Disorders:

  • involves disturbance to how ppl perceive reality, think, and behave

  • can be acute or chronic

Symptoms:

  • Delusions (adds to behavior/mind so positive symptom)

  • Hallucinations (positive)

  • Disorganized thinking/speaking/behavior (negative)

  • Negative symptoms (things taken away like function)

(DHDN to memorize)

Causes:

Genetic:

  • family history

  • specific gene variations

Biological:

  • prenatal virus exposer (ex. influenza)

  • neurotransmitter imbalance (dopamine hypothesis)

Environmental:

  • stressful/traumatic life events

  • substance abuse (especially cannabis)

  • social isolation

  • complications during childbirth/pregnancy

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Depressive Disorders:

  • involves persistent sadness and effects daily life

Types of Depressive Disorders:

  • Major Depressive Disorder (MDD): persistent sadness, loss of interest, etc. for 2+ weeks

  • Persistent Depressive Disorder (Dysthymia): chronic, less severe form of depression, lasts 2+ years, can appear more functional

  • Premenstrual Dysphoric Disorder (PMDD): depressive symptoms linked to menstrual cycle

  • Seasonal Affective Disorder (SAD): depression related to seasons (usually winter) and goes under MDD

Symptoms:

  • persistent sad, empty, irritable moods

  • changes in sleep, appetite, energy, self esteem

  • interferes with work, school, relationships

Causes:

Genetic:

  • family history

  • specific gene variations

  • environmental triggers

Biological:

  • hormonal changes

  • brain structure/abnormalities

  • neurotransmitter imbalance (serotonin, norepinephrine, dopamine)

Social & Cultural:

  • stressful/traumatic life events

  • cultural pressures

  • social isolation/lack of support

Behavioral:

  • learned helplessness

  • lack of positivity

  • maladaptive coping

Cognitive:

  • negative thinking patterns

  • pessimistic interpretations

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Bipolar Disorders:

  • dramatic mood swings between mania and depression

Levels of Bipolar

  • Bipolar I: full manic episodes

  • Bipolar II: Hypomania (less severe mania)

Symptoms:

  • switch between mania and depression

  • manic episodes

  • depressive episodes

  • varied length and frequency of episodes

Causes:

Genetic:

  • family history

  • specific gene variations

  • environmental triggers

Biological:

  • disruptions in circadian rhythms (sleep)

  • brain structure/abnormalities

  • neurotransmitter imbalance (serotonin, norepinephrine, dopamine)

Social & Cultural:

  • stressful/traumatic life events

  • lack of social support

  • cultural stigma

Behavioral:

  • irregular sleep schedules

  • substance abuse

  • lack of treatment adherence (how well u follow treatment plans)

Cognitive:

  • negative thinking during depression

  • difficulty regulating emotions

  • grandiose thinking (thinking they can do anything) during mania

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Dissociative Disorders:

  • disrupts consciousness, memory, and identity

  • symptoms can be sudden or chronic

Types of Dissociative Disorders:

  • dissociative amnesia: inability to recall personal info

  • dissociative fugue: amnesia with unexpected travel/wandering

  • dissociative identity disorder (DID): 2 or more distinct personality states

Symptoms:

  • feelings of detachment from thoughts, feelings, body, or surrounding

  • disruptions in consciousness, memory, identity, emotion, perception, motor control, behavior

Causes:

Traumatic Experiences:

  • exposure to severe, repeated trauma (especially during childhood)

  • witnessing life-threatening events

  • dissociation as coping method

  • childhood abuse/neglect

Chronic Stress:

  • persistent high levels of stress

  • lack of healthy coping strategies

Genetic & Biological:

  • family history

  • brain structure/abnormalities (memory, emotion processing

  • environmental stressors

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Trauma Disorders: distress from exposure to traumatic event/s

  • can be acute or chronic

  • impairs social, occupational, academic fucntioning

Post Traumatic Stress Disorder (PTSD): severe reaction to a trigger to a traumatic event

Symptoms:

  • flashbacks

  • unable to sleep

  • heightened anxiety

  • aggression

  • irritability or aggressive behavior

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Eating Disorders: distress from abnormal eating patterns

  • usually overlaps with other mental health issues

Types of Eating Disorders:

  • Anorexia Nervosa: restriction of food, fear of weight gain, overexercising

  • Bulimia Nervosa: binging → purging

  • Binge Eating Disorder: uncontrollable binging → distress after eating

Treatments

Psychotherapy: talking therapy, addresses emotional and behavioral issues

why it works:

  • uses meta-analysis: researchers combining a bunch of studies to find trends

  • uses evidence-based interventions: types of therapies that are proven to work

  • makes sure there’s a therapeutic alliance: trusting/positive relationship between therapist and patient

  • makes sure cultural humility is used: therapists respect for patients cultural background

Psychological Therapies:

  • Free Association: patient saying whatever comes to their head, with no censoring

  • Dream Interpretation: analyzes dreams to understand the unconscious mind and find the hidden issues

Cognitive Therapies: (focuses on inside thoughts/beliefs)

  • Cognitive Restructuring: identifying and going against the bad/distorted thoughts → changes thinking patterns

  • Fear Hierarchies: list of ranked fear situations/stimuli → overcomes anxiety/phobias

         ex. someone has phobia of dogs

                    1. looking at dog photo (10%)

                    2. seeing dog across street (30%)

                    3. standing 5 feet from leashed dog (50%)

                    4. petting calm dog (80%)

  • Cognitive Triad: targets triad by recognizing and changing the negative thought patterns
    triad:

            1. self: “im worthless”

            2. world: “everything is unfair”

            3. future: “things will never get better”

Applied Behavior Analysis Techniques:

  • Exposure Therapies: slowly exposing patient to feared stimuli while teaching them relaxation techniques

  • Aversion Therapies: pairing bad behaviors with unpleasant stimuli

            ex. pairing smoking with nausea-inducing meds → creates negative association

  • Token Economies: rewards good behavior with tokens that can be exchanged for reward (like a game)

            ex. students earning stickers for good behavior → 10 stickers = pizza party

  • Biofeedback: using something to help track, understand, regulate your symptoms

            ex. glucose monitor for diabetes

Cognitive-Behavioral Therapy Integration:

DBT (Dialectical Behavior Therapy): type of cognitive/behavioral therapy for helping ppl deal with intense emotions, and tolerate distress

  • og made for BPD

  • helps depression, binge eating, substance use disorders, PTSD

REBT (Rational-Emotive Behavior Therapy): helps notice unrealistic/harmful thoughts

  • made by Albert Ellis

        ex. “i have to be perfect or im a failure” → “i can make mistakes and still be ok”

Person-Centered Therapy Focus (Client-Centered Therapy):

Active Listening: understanding, respecting, being attentive to patients perspective

Unconditional Positive Regard: therapist accepting/supporting patients feelings/actions no matter what (creates safe space)

  • Carl Rodgers

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Hypnosis in Treatment

Pain and Anxiety Management:

  • can help manage chronic pain and reducing anxiety

IMPORTANT:

  • hypnosis can alter memories so its not reliable for remembering the past

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Group Therapy: multiple patients with one or more therapists, provides peer support, feedback and practices social skills

Individual Therapy: one-on-one sessions, more personalized attention

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Medication: using drugs to balance brain chem

psychotropic medicine: drugs that affect mental states/behaviors

  • antidepressants (ex. prozac): boosts mood

  • antipsychotics (ex. thorazine): helps with psychotic symptoms

  • mood stabilizers (ex. lithium): balances mood swings

Biological Interventions

Psychoactive Medication and Neurotransmitters

  • Antidepressants (SSRIs, SNRIs): Increases serotonin and norepinephrine in brain → regulates mood

  • Antianxiety Medications (benzodiazepines): enhances effects of GABA → less anxiety symptoms

  • Lithium: mood stabilizer, regulates neurotransmitter activity

  • Tardive Dyskinesia: potential long/short term serious side effect of antipsychotics with involuntary movements

  • Antipsychotic Medications (typical and atypical): targets dopamine, neurotransmitters to manage psychotic symptoms

Feature

Typical (1st Gen)

Atypical (2nd Gen)

Main action

Dopamine blockade (D2)

Dopamine + serotonin blockade

Treats

Mostly positive symptoms

Positive and some negative

Movement side effects

High risk

Lower risk

Metabolic side effects

Lower risk

Higher risk (weight, blood sugar)

Example drugs

Haloperidol, Chlorpromazine

Risperidone, Olanzapine, Clozapine

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Surgical and Invasive Procedures

  • Psychosurgery: surgical interventions on brain to treat severe mental illnesses

  • Lesioning Procedures: destroying small parts of brain that are thought to contribute to disorder

  • TMS (Transcranial Magnetic Stimulation): uses magnetic fields to stimulate inhibit brain activity

  • ECT (Electroconvulsive Therapy): induces controlled seizures using electrical stimulation

  • Lobotomy: severing connections in prefrontal cortex (no longer used)

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Combination: using both drugs and psychotherapy

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Deinstitutionalized: shift from long stay in a mental hospital to a community based care    

Decentralized Treatment: making treatment more accessible

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APA Guidelines for Psychologists:

  1. Nonmaleficence: “do no harm”

  2. Fidelity: be loyal, truthful and keep promises

  3. Integrity: be accurate, honest in all practices

  4. Respect for peoples rights and dignity: rights to privacy, humans, confidentiality